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Cooper RA, Harwood J. Humanizing Dementia: Effects of Counter-Stereotypical Messages on Patronizing Speech toward People with a Stigmatized Health Condition. HEALTH COMMUNICATION 2024; 39:1175-1184. [PMID: 37161315 DOI: 10.1080/10410236.2023.2207281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Patronizing speech and dehumanization both have negative impacts on the health and wellbeing of the recipients of these behaviors. This experiment applied Fiske's stereotype content model, Haslam's dual model of dehumanization, and Hummert's model of patronizing speech to assess the effects of warmth- and competence-enhancing messages about a person with dementia on perceptions of humanness and patronizing speech toward people with dementia. Results supported our predictions that warmth- and competence-enhancing messages would translate into general tendencies to humanize people with dementia as a group. Predicted effects on patronizing communication did not materialize, but there were some unanticipated ways in which warmth- and competence-enhancing messages did influence intentions to use patronizing speech.
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Affiliation(s)
| | - Jake Harwood
- Department of Communication, University of Arizona
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2
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Kim S, Liu W, Daack-Hirsch S, Williams KN. Communication Patterns and Characteristics of Family Caregivers and Persons Living With Dementia: Secondary Analysis of Video Observation. West J Nurs Res 2024; 46:264-277. [PMID: 38400741 PMCID: PMC10955794 DOI: 10.1177/01939459241233360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2024]
Abstract
BACKGROUND It is essential to characterize communication patterns for better health outcomes for family caregivers and persons living with dementia. OBJECTIVE This study aimed to examine the relationships between communication patterns and the characteristics of dyads of family caregivers and persons living with dementia. METHODS A secondary analysis was conducted using 75 video-recorded home care observations from 19 dyads. Participant characteristics and caregiver burden, depression, and sense of competence were collected from the parent study. The video-recorded dyadic communication patterns were assessed using a coding scheme developed based on Communication Accommodation Theory and Classical Test Theory. The relative frequency of the communication patterns was compared between groups. RESULTS Overall, 8311 caregiver and 8024 care recipient communication behaviors were observed. Caregiver communication patterns were categorized as facilitative, disabling, and neutral. Care recipient communication patterns were categorized as engaging, challenging, and neutral. Caregiver gender, care recipient gender, care recipient education level, dementia diagnosis length, types of dementia, dyadic gender difference, burden, depression, and competence of caregiver, and types of communication were significantly associated with caregiver communication. Dementia diagnosis length, caregiver competence, dyadic gender difference, and types of communication were significantly associated with care recipient communication. CONCLUSIONS The findings demonstrated different communication patterns depending on individual and dyad characteristics and evidence for dyadic communication support to promote meaningful interaction for persons living with dementia. Further analysis is needed to identify mediating factors and causal relationships.
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Affiliation(s)
- Sohyun Kim
- College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, TX, USA
| | - Wen Liu
- The University of Iowa, Iowa City, IA, USA
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3
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Haunch K, Downs M, Oyebode J. 'Making the most of time during personal care': nursing home staff experiences of meaningful engagement with residents with advanced dementia. Aging Ment Health 2023; 27:2346-2354. [PMID: 36786726 DOI: 10.1080/13607863.2023.2177254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/24/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVES Dementia progressively affects cognitive functioning, including the ability to communicate. Those who struggle to communicate are often considered unable to relate to other people. Frontline care workers are in a position to connect with residents. However, we know little about their perspectives. The aim of this study was to understand how and when nursing home staff meaningfully engaged with residents with advanced dementia. METHODS Semi-structured interviews, supplemented by informal conversations, were conducted with 21 staff from seven nursing homes. Inductive thematic analysis identified themes in the accounts. RESULTS Four themes related to how staff engaged with residents with advanced dementia (initiating meaningful engagement, recognising subtle reactions, practising caring behaviours, patience and perseverance). Two themes related to when meaningful engagement occurred (lacking time to connect, making the most of time during personal care). CONCLUSION A key barrier to implementing formal interventions to improve care is lack of staff time. Staff overcome this by using personal care time for meaningful engagement with residents. Their approach, developed through experience, is consonant with person-centred dementia care. Building on this, future research should use participatory approaches building on practice wisdom to further develop and evaluate meaningful engagement with residents with advanced dementia.
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Affiliation(s)
- Kirsty Haunch
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Murna Downs
- Centre for Applied Dementia, University of Bradford, Bradford, UK
| | - Jan Oyebode
- Centre for Applied Dementia, University of Bradford, Bradford, UK
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Dhanda N, Pryce H. An ethnography study exploring factors that influence social isolation in care home residents living with dementia and hearing loss. BMC Geriatr 2023; 23:593. [PMID: 37749500 PMCID: PMC10518931 DOI: 10.1186/s12877-023-04296-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/08/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Hearing loss and dementia are highly prevalent conditions amongst older adults living in residential care. The consequences of living with these conditions may include social withdrawal and reduced communication opportunities. We sought to examine patterns of communication and interaction in residential care and explore resident, staff, and relative perspectives within two care homes located in Birmingham, UK. This enabled an understanding of how communication environments contributed to social isolation. METHODS This work used ethnography methodology to explore mechanisms that created and maintained social isolation in older adults living with dementia and hearing loss. A planning and engagement phase took place in four care homes. This was followed by an environmental audit, observations, and interviews. Data generated were analysed using Grounded Theory methods. RESULTS There were 33 participants (16 residents, 11 care staff, and six relatives) who took part in the observations and interviews. Residents experienced social isolation through lack of meaningful conversation with others and being misunderstood. Additionally, observations of residents' interactions informed the overall findings. A Grounded Theory model was employed to explain the core phenomenon of social isolation. The main contributors were internal and external barriers to communication, and reduced opportunities for meaningful conversation. CONCLUSIONS There is a wide range of social isolation that care home residents experience. This was not always associated with the severity of hearing loss but rather communication ability. Simple interventions such as staff dining with residents and focussing on improving communication could reduce social isolation within residential care settings.
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Affiliation(s)
- Nisha Dhanda
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
- University of Birmingham Dubai, Dubai International Academic City, PO Box 341799, United Arab Emirates.
| | - Helen Pryce
- College of Health and Life Sciences, Aston University, Birmingham, UK
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Dokos M, Schultz R, Gossner JD, Fauth EB. Supporting Persons With Dementia: Perspectives From Certified Nurse's Assistants. Innov Aging 2023; 7:igad049. [PMID: 37476503 PMCID: PMC10355141 DOI: 10.1093/geroni/igad049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Indexed: 07/22/2023] Open
Abstract
Background and Objectives Many persons with Alzheimer's disease or related dementias (ADRD) receive care from paid staff in residential communities. The most common staff in these communities are certified nursing assistants (CNAs). Although CNAs have a high number of interactions with residents, and thus the possibility of engaging in social interactions, evidence suggests that they provide limited social support to persons with ADRD. Little is known about the attitudes of CNAs toward providing social support to persons with ADRD and their perception of components of quality social interactions with these individuals. Research Design and Methods We conducted a thematic analysis of semistructured interviews with 11 CNAs (91% female participants, mean age 23.6) to understand their perceptions about providing social support to persons with ADRD and the components of effective social interactions. Results Our results show that CNAs consider providing social support to be an important part of their role as CNAs. Additionally, participants emphasized the interplay of verbal communication, nonverbal communication, and internal beliefs and attitudes toward persons with ADRD in creating effective social interactions. Participants highlighted multiple barriers to providing residents with social support, including lack of time, lack of training, and the behavioral and psychological symptoms of dementia. Discussion and Implications We offer implications for expanding training for CNAs working with persons with dementia and improving policy based on our results.
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Affiliation(s)
- Malinda Dokos
- Department of Human Development and Family Studies, Utah State University, Logan, Utah, USA
| | - Rebecka Schultz
- Department of Human Development and Family Studies, Utah State University, Logan, Utah, USA
| | - Jacob D Gossner
- Department of Human Development and Family Studies, Utah State University, Logan, Utah, USA
| | - Elizabeth B Fauth
- Department of Human Development and Family Studies, Utah State University, Logan, Utah, USA
- Alzheimer’s Disease and Dementia Research Center, Utah State University, Logan, Utah, USA
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Sato W, Nakazawa A, Yoshikawa S, Kochiyama T, Honda M, Gineste Y. Behavioral and neural underpinnings of empathic characteristics in a Humanitude-care expert. Front Med (Lausanne) 2023; 10:1059203. [PMID: 37305136 PMCID: PMC10248535 DOI: 10.3389/fmed.2023.1059203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 05/04/2023] [Indexed: 06/13/2023] Open
Abstract
Background Humanitude approaches have shown positive effects in elderly care. However, the behavioral and neural underpinnings of empathic characteristics in Humanitude-care experts remain unknown. Methods We investigated the empathic characteristics of a Humanitude-care expert (YG) and those of age-, sex-, and race-matched controls (n = 13). In a behavioral study, we measured subjective valence and arousal ratings and facial electromyography (EMG) of the corrugator supercilii and zygomatic major muscles while participants passively observed dynamic facial expressions associated with anger and happiness and their randomized mosaic patterns. In a functional magnetic resonance imaging (MRI) study, we measured brain activity while participants passively observed the same dynamic facial expressions and mosaics. In a structural MRI study, we acquired structural MRI data and analyzed gray matter volume. Results Our behavioral data showed that YG experienced higher subjective arousal and showed stronger facial EMG activity congruent with stimulus facial expressions compared with controls. The functional MRI data demonstrated that YG showed stronger activity in the ventral premotor cortex (PMv; covering the precentral gyrus and inferior frontal gyrus) and posterior middle temporal gyrus in the right hemisphere in response to dynamic facial expressions versus dynamic mosaics compared with controls. The structural MRI data revealed higher regional gray matter volume in the right PMv in YG than in controls. Conclusion These results suggest that Humanitude-care experts have behavioral and neural characteristics associated with empathic social interactions.
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Affiliation(s)
- Wataru Sato
- Psychological Process Research Team, Guardian Robot Project, RIKEN, Soraku-gun, Japan
| | - Atsushi Nakazawa
- Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama, Japan
| | | | | | - Miwako Honda
- Department of Geriatric Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yves Gineste
- Department of Geriatric Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
- IGM-France, Saint-Laurent-de-la-Salanque, France
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Waters B, Orrell M, McDermott O. The Development of a UK Culturally Adapted and Modified Version of the Person Attuned Musical Interactions Manual: Protocol for a 2-Phase Mixed Methods Study. JMIR Res Protoc 2023; 12:e43408. [PMID: 37071461 PMCID: PMC10155094 DOI: 10.2196/43408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/07/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Previous research has suggested that care home interactions need significant improvements, especially those between staff and residents with dementia. Reasons for the lack of interactions are staff time pressures and residents' language impairments. Although residents may experience reduced language abilities, they can continue to communicate through other forms, including nonverbal communication and music. Person Attuned Musical Interactions (PAMI) is a staff training tool that provides staff with music therapy skill-sharing to promote high-quality interactions between staff and residents using nonverbal communication and music. The tool was originally developed in Denmark. To ensure that the tool is appropriate for UK care homes, a team of researchers in the United Kingdom have modified and culturally adapted the tool. OBJECTIVE This study aims to investigate the appropriateness of the adapted and modified manual for UK care homes and to explore the impact of PAMI on residents with dementia and care staff. METHODS The project consists of 2 phases, a qualitative field-testing study and a mixed methods evaluation study, which have been developed following the Medical Research Council's guidelines for complex interventions. Care staff and residents with dementia will be recruited from care homes in Lincolnshire, where the care staff will be trained in the PAMI intervention before implementing the intervention in their daily routines. Fortnightly reflective sessions will be provided throughout the phases to provide supervision and monitoring. The qualitative methods include interviews, reflective session transcripts, diary entries, and resident experience questionnaires. The quantitative outcome measures are residents' music engagement, staff's dementia competence, residents' quality of life, and staff burden. The resident's music engagement will be administered at 9 fortnightly time points. Staff's dementia competence, resident's quality of life, and staff burden will be administered at preintervention and postintervention time points. RESULTS The study has been funded by The Music Therapy Charity as part of a PhD studentship. The study began recruiting in September 2021. The research team aims to publish the results of the first phase in July to September 2023 and those of the second phase in October to December 2023. CONCLUSIONS This study will be the first to investigate the modified version of PAMI. Therefore, it will provide feedback on the appropriateness of the manual for UK care homes. The PAMI intervention has the potential to offer high-quality music intervention training to a larger population of care homes who may currently be restricted by finances, the availability of time, and a lack of training opportunities. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/43408.
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Affiliation(s)
- Bryony Waters
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Martin Orrell
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Orii McDermott
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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Sánchez-Martínez I, Celdrán M, Jerez-Roig J. “Now I Understand You”: Changes in the Communication of Professionals in Nursing Homes After Receiving Training in the Validation Method. J Contin Educ Nurs 2023; 54:157-168. [PMID: 37001125 DOI: 10.3928/00220124-20230310-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Caring for older persons is a challenge for professionals who work in nursing homes. Problems in maintaining effective communication with a person with dementia in an effort to understand their needs is a major barrier to good care. Therefore, the main goals of this study were to explore communication barriers between professionals and people with dementia and to observe changes in communication patterns between them after completing Naomi Feil's introductory training in the bases of the validation method (BVM). The 11 professionals who worked in nursing homes attended a 16-hour introductory course on BVM. Participants were interviewed individually three times. The goal was to observe qualitatively the changes in relationships and communication patterns with people with dementia. The results were analyzed thematically. The professionals highlighted how, after the training, they had a different understanding of the person with dementia and a more humane perspective. These changes also reflected how the professionals experienced improvements in job satisfaction, security, and confidence. This study concluded that training nursing home staff in BVM for person-centered and human care has positive implications on how the professionals view their daily work and their way of interacting with older residents. [J Contin Educ Nurs. 2023;54(4):157-168.].
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Fallahpour M, Nygård L, Asaba E. Communication and engagement as potentiality in everyday life between persons with young onset dementia living in a nursing home and caregivers. Int J Qual Stud Health Well-being 2022; 17:2035305. [PMID: 35133256 PMCID: PMC8925924 DOI: 10.1080/17482631.2022.2035305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives To explore communication and engagement in everyday situations between persons with young-onset dementia (YOD) living in a nursing home (NH) and the caregivers. Methods The study draws on ethnographic methods aligned with participatory design. Three residents with YOD living in a NH and eight staff members were recruited. A narrative approach was used for data collection and analysis. Findings Three narrative vignettes were developed representing everyday situations in which communication and engagement was enacted among residents and caregiver staff: (a) waiting for something to happen, (b) tensions about everyday communication, and (c) negotiating a combined living + working environment. The findings stress a paradoxical tension rooted in the NH as residence and workplace as well as place of calm and place of boredom. The everyday situations are interpreted differently from the perspective of the residents and staff. Conclusion The identified paradox of planned and spontaneous situations influences communication and engagement in everyday life, and the potentiality for active engagement embedded in contexts of units for residents with YOD. The degree to which everyday activities and encounters are redefined and renegotiated is an important part of caregiving practices in NH settings for residents with YOD.
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Affiliation(s)
- Mandana Fallahpour
- Department of Neurobiology, Care Sciences and Society (Nvs), Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
| | - Louise Nygård
- Department of Neurobiology, Care Sciences and Society (Nvs), Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
| | - Eric Asaba
- Department of Neurobiology, Care Sciences and Society (Nvs), Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
- Unit for Research, Education, Development, & Innovation, Stockholms Sjukhem Foundation, Stockholm, Sweden
- Department of Health Sciences, Occupational Science and Occupational Therapy Research Group, Lund University, Lund, Sweden
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10
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Haunch K, Downs M, Oyebode J. Leading by example: Nursing home staff experiences of what facilitates them to meaningfully engage with residents with advanced dementia. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5805. [PMID: 36040653 PMCID: PMC9541111 DOI: 10.1002/gps.5805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 08/12/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Meaningful connections promote the quality of life of people living with advanced dementia in nursing homes. However, evidence internationally suggests people living with advanced dementia in nursing homes spend the majority of time alone, with little contact with anyone. Frontline care workers are in powerful positions to meaningfully engage with residents, yet research to date has not focused on their experiences. The aim of this study was to explore the experiences of nursing home staff, specifically, what care workers feel enables them to meaningfully engage with residents living with advanced dementia. METHODS/DESIGN Semi-structured interviews were conducted with 21 staff from seven nursing homes. Inductive thematic analysis was used. RESULTS Four themes were important for facilitating care workers to meaningfully engage with residents with advanced dementia: support from managers and nurses, support from experienced care workers, a caring culture and an appropriate physical environment. CONCLUSION Effective leadership was the key thread that ran throughout. It was evident that meaningfully engaging with residents with advanced dementia was hard, particularly for new or inexperienced care workers. Those with experience (of care work and the residents they cared for), as well as those in formal leadership positions played key roles in facilitating care workers to: perceive it was their role to connect, understand, accept and empathise with residents, understand the importance of getting to know residents' and express their own caring attributes. Future research should focus on empirically testing leadership models that promote meaningful engagement.
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Relational Care, Dementia, and Communication Challenges in Long-Term Care: A Meta-Ethnography. Can J Aging 2022; 42:259-270. [PMID: 35817789 DOI: 10.1017/s0714980822000253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Few studies examine care as a relational process in long-term care, and still fewer describe the participation of residents with dementia. In this article, our objective was to understand the development of knowledge in this area by means of a meta-ethnography. Our search and selection process resulted in six eligible articles. Each documents a qualitative study of resident-staff interactions during care activities in a residential care setting, and includes participants with dementia. Tronto's 4 Phases of Care were used to guide the identification of relational care practices within the articles selected. We identified five translatable concepts across the six studies: (1) doing with versus doing for, (2) staff responsiveness, (3) resident agency, (4) inclusive communication, and (5) time. In our new configuration of relational care, we combine these concepts to delineate an "interactive space" in which the agency of residents and initiative of staff are equally visible.
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Waters B, Sousa L, Orrell M, McDermott O. Analysing the use of music to facilitate social interaction in care home residents with dementia: Narrative synthesis systematic review. DEMENTIA 2022; 21:2072-2094. [PMID: 35593422 DOI: 10.1177/14713012221100625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Individuals with dementia residing in care homes can rely heavily on care staff to access activities and meaningful interactions. Previous research suggests that care home interactions can be short, fragmented and task-orientated due to staff workload and residents' language impairments. However, music has the potential to be an alternative communication form that remains intact in the later stages of dementia. This systematic review aims to explore how care home music interventions can facilitate social interactions. METHODS A narrative synthesis was conducted to explore the mechanisms behind how and why care home music intervention facilitate social interactions. The four-element framework guided analysis; (1) Developing a theory, (2) Developing a preliminary synthesis, (3) Exploring relationships, (4) Assessing robustness. FINDINGS The final synthesis included 23 articles. The studies consisted of music therapy sessions, personalised music listening, structured music singing or instrument playing sessions and music therapeutic care. Despite the difference in music interventions, most studies reported an increase in residents' sociable verbal and non-verbal communication and a decrease in unsociable communication. Music interventions allowed residents to reminisce, express themselves, focus and connect with others. DISCUSSION The studies highlighted music interventions are accessible to all residents with dementia despite their impairments. The adaptability allows individuals to continue to connect and express themselves even when language deteriorates. More research is needed into the enablers and barriers to implementing interventions into practice, as this systematic review has highlighted that some form of music intervention for all residents can be highly beneficial. Care homes use of music could increase social interactions and meaningful activities.
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Affiliation(s)
- Bryony Waters
- School of Medicine, Institute of Mental Health, 6123University of Nottingham, UK
| | - Lídia Sousa
- Faculty of Medicine of Porto University, 59043Center of Health Technologies and Services Research - CINTESIS, Portugal
| | - Martin Orrell
- School of Medicine, Institute of Mental Health, University of Nottingham, UK
| | - Orii McDermott
- School of Medicine, Institute of Mental Health, 6123University of Nottingham, UK
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Sun F, Opur FA, Kim HN, Prieto LR, Conyers C. Dementia-friendly initiatives within the context of COVID-19 pandemic: Challenges and strategies perceived by service professional stakeholders from the USA and China. DEMENTIA 2022; 21:1714-1733. [PMID: 35470700 PMCID: PMC9047609 DOI: 10.1177/14713012221089416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Purposes Dementia-friendly initiatives (DFI) are community-based movements aimed to
address stigma, exclusion, and discrimination associated with dementia. This
study examined the challenges faced and strategies used by DFI prior to and
during the COVID-19 pandemic from the perspectives of stakeholders in the
USA and China. Methods Qualitative interviews with 17 stakeholders involved in DFI from the United
States and mainland China were conducted via the Zoom platform.
Semi-structured interview questions focused on DFI challenges and strategies
prior to and during the pandemic. Thematic analysis was used to analyze the
data. Results Three major challenges prior to the COVID-19 pandemic included low
participation of persons with dementia, difficulties in building community
collaborations, and limited funding and resources needed to sustain DFI.
During the COVID-19 pandemic, challenges included exacerbated difficulties
of involving persons with dementia and reduced policy support for DFI.
Strategies implemented prior to COVID-19 included partnerships with
community organizations to outreach and engage persons with dementia, and
coordination of resources and diversification of funding sources to sustain
DFI. Strategies during the COVID-19 pandemic centered on the implementation
of person-centered technology to support persons with dementia and family
caregivers, and the development of new programs that integrated efforts to
address the impact of COVID-19. Implications DFI in the USA and mainland China shared similar challenges for DFI prior to
and during COVID-19. During the COVID-19 pandemic, DFI in both countries
showed resourcefulness through reliance on technology, community
collaboration, and COVID-19–related resources to provide support and
services. While it remains critical to advocate to the central government to
fund DFI, DFI in both societies need to be open to other funding sources,
hire persons with dementia as key staff members of DFI, and demonstrate its
effectiveness through rigorous evaluation.
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Affiliation(s)
- Fei Sun
- School of Social Work, 3078Michigan State University, East Lansing, MI, USA
| | - Fredrika A Opur
- School of Social Work, 3078Michigan State University, East Lansing, MI, USA
| | - Ha-Neul Kim
- School of Social Work, 3078Michigan State University, East Lansing, MI, USA
| | - Lucas R Prieto
- School of Social Work, 3078Michigan State University, East Lansing, MI, USA
| | - Christian Conyers
- School of Social Work, 1259University of Michigan, Ann Arbor, MI, USA
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Nguyen H, Eccleston CE, Doherty KV, Jang S, McInerney F. Communication in dementia care: Experiences and needs of carers. DEMENTIA 2022; 21:1381-1398. [PMID: 35333128 DOI: 10.1177/14713012221080003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To ensure the well-being, quality of life and quality of care of people living with dementia, carers need to have the necessary communication knowledge and skills to respond appropriately to a person's changing abilities and needs. Understanding carers' communication experiences and needs in the context of dementia care is an important step in enabling effective education and support for carers. This study aimed to investigate communication challenges faced by carers and their coping strategies, influencing factors, and communication education and training needs. The sample involved 258 carers enrolled in an online dementia care program, and data were collected using a 16-item questionnaire. Descriptive statistics and non-parametric inferential statistics, including Chi-square, Mann-Whitney U, Kruskal-Wallis and Spearman's rho, were used to analyse the data. The participants reported experiencing a range of challenges in communicating with people living with dementia and employing various strategies in addressing these challenges, either independently or with the support of others. Improvements in a number of factors would be beneficial for carers, including more time for caring, more care and social support, as well as enhanced skills in communicating with people living with dementia. A large majority of the participants indicated their need for education or training in communication knowledge and skills, and those with higher learning needs were likely to be younger, care workers and other health professionals, and those with less care experience. Recommendations are made for future research and efforts to maximise effective education and support for carers of people living with dementia.
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Affiliation(s)
- Hoang Nguyen
- Wicking Dementia Research & Education Centre, College of Health and Medicine, 3925University of Tasmania, Hobart AU-TAS 7001, Australia
| | - Claire Ea Eccleston
- Wicking Dementia Research & Education Centre, College of Health and Medicine, 3925University of Tasmania, Hobart AU-TAS 7001, Australia
| | - Kathleen Veronica Doherty
- Wicking Dementia Research & Education Centre, College of Health and Medicine, 3925University of Tasmania, Hobart AU-TAS 7001, Australia
| | - Sunny Jang
- Wicking Dementia Research & Education Centre, College of Health and Medicine, 3925University of Tasmania, Hobart AU-TAS 7001, Australia
| | - Fran McInerney
- Wicking Dementia Research & Education Centre, College of Health and Medicine, 3925University of Tasmania, Hobart AU-TAS 7001, Australia
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Collins R, Hunt A, Quinn C, Martyr A, Pentecost C, Clare L. Methods and approaches for enhancing communication with people with moderate-to-severe dementia that can facilitate their inclusion in research and service evaluation: Findings from the IDEAL programme. DEMENTIA 2022; 21:1135-1153. [PMID: 35156412 PMCID: PMC9109550 DOI: 10.1177/14713012211069449] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Dementia can affect language processing and production, making communication more
difficult. This creates challenges for including the person’s perspective in research
and service evaluation. This study aims to identify methods, tools and approaches that
could facilitate meaningful communication with people with moderate-to-severe dementia
and support the inclusion of their perspectives. Methods This qualitative study was conducted as part of the IDEAL programme and involved
in-depth, semi-structured interviews with 17 dementia research and/or care professionals
with expertise in communication. Transcripts were analysed using framework analysis. Findings Three main themes each with sub-themes were identified: (1) Awareness, knowledge and
experience; (2) Communication approach and (3) Personalization. A person-centred
orientation based on getting to know the participant and developing a bi-directional
exchange formed the fundamental context for effective communication. Building on this
foundation, an approach using pictures, photographs or objects that are meaningful to
the person and appropriate for that person’s preferences and ability could help to
facilitate conversations. The findings were integrated into a diagram illustrating how
the topics covered by the themes interrelate to facilitate communication. Conclusions Useful skills and approaches were identified to help researchers engage and work with
people with moderate-to-severe dementia and ensure their perspective is included. These
covered getting to know the participant, using a variety of tangible tools and
interactional techniques and considering the environment and context of the
conversation.
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Affiliation(s)
- Rachel Collins
- College of Medicine and Health, 3286University of Exeter, Exeter, UK
| | - Anna Hunt
- College of Medicine and Health, 3286University of Exeter, Exeter, UK
| | - Catherine Quinn
- The Centre for Applied Dementia Studies, 1905University of Bradford, Bradford, UK; Wolfson Centre for Applied Health Research, Bradford, UK
| | - Anthony Martyr
- College of Medicine and Health, 3286University of Exeter, Exeter, UK
| | - Claire Pentecost
- College of Medicine and Health, 3286University of Exeter, Exeter, UK
| | - Linda Clare
- College of Medicine and Health, 3286University of Exeter, Exeter, UK; 3286NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
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16
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Cohen L, Sher-Censor E, Oppenheim D, Dassa A, Ayalon L, Palgi Y. Emotional availability in dyads of nursing aide - resident with dementia: Old tool, new perspective. DEMENTIA 2022; 21:882-898. [DOI: 10.1177/14713012211065396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives This study examined the emotional availability of nursing aide-resident with dementia dyads in a long-term care-facility. Emotional availability refers to the nursing aide’s sensitivity toward the resident, structuring their interactions in a non-intrusive and non-hostile manner and the resident’s responsiveness to and involvement of the nursing aide. The study evaluated the reciprocity in the emotional availability of nursing aides and the residents and examined whether emotional availability varies with the level of difficulty of taking care of the residents and with the context of the interaction. Method The study was conducted in three wards in one long-term care-facility. Twenty nursing aides and 40 residents took part in the study. Each nursing aide was videotaped during feeding, structured and unstructured interactions, with two residents, one that was nominated by the head nurse as difficult to take care of and one that was nominated as easy to take care of. The interactions were coded using the emotional availability scales. Results Linear mixed-effect model analyses indicated that higher emotional availability of nursing aides was related to higher emotional availability of the residents. Nursing aides’ emotional availability did not vary between “difficult” and “easy” residents or across the three interaction contexts. “Difficult” residents involved their nursing aides less than “easy” residents. Discussion The study documented the reciprocal nature of the interaction between nursing aides and residents with dementia. It suggests that nursing aides have an important role in promoting residents’ responsiveness and involvement.
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Affiliation(s)
- Liora Cohen
- Department of Gerontology, University of Haifa, Haifa, Israel
| | - Efrat Sher-Censor
- School of Psychological Sciences and the Center for the Study of Child Development, University of Haifa, Haifa, Israel
| | - David Oppenheim
- School of Psychological Sciences and the Center for the Study of Child Development, University of Haifa, Haifa, Israel
| | - Ayelet Dassa
- Music Department, Bar-Ilan University, Ramat-Gan, Israel
| | - Liat Ayalon
- Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat-Gan, Israel
| | - Yuval Palgi
- Department of Gerontology, University of Haifa, Israel
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17
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Krøier JK, McDermott O, Ridder HM. Conceptualizing attunement in dementia care: a meta-ethnographic review. Arts Health 2022; 14:32-48. [DOI: 10.1080/17533015.2020.1827276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Julie Kolbe Krøier
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
| | - Orii McDermott
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Hanne Mette Ridder
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
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18
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Mabire JB, Gay MC, Charras K, Vernooij-Dassen M. Impact of a Psychosocial Intervention on Social Interactions between People with Dementia: An Observational Study in a Nursing Home. ACTIVITIES, ADAPTATION & AGING 2021. [DOI: 10.1080/01924788.2021.1966574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
| | | | - Kevin Charras
- Living lab Vieillissement et Vulnérabilités, Service de Gériatrie, CHU de Rennes, Rennes, France
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19
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Kamalraj P, Savundranayagam MY, Orange JB, Kloseck M. Communication in home care: Understanding the lived experiences of formal caregivers communicating with persons living with dementia. Int J Older People Nurs 2021; 16:e12401. [PMID: 34337872 DOI: 10.1111/opn.12401] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/05/2021] [Accepted: 06/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Little is known about formal caregivers' lived experiences communicating with persons living with dementia (PLWD) who live in their own homes. Most information comes from research conducted in long-term care settings or home care settings involving family care partners. Yet, there are expected needs and rising demands for formal caregivers to provide support within clients' homes. OBJECTIVES Accordingly, this study aimed to understand the lived experiences of personal support workers (PSWs) regarding their communication with PLWD who live in their own homes. METHODS The study was grounded in a hermeneutic phenomenological research approach. Data were collected as part of the Be EPIC project, an evidence-informed, person-centred communication intervention for PSWs caring for PLWD. One, in-depth semi-structured interview was conducted with each of the PSWs (N = 15). Thematic analysis was completed on the interviews. RESULTS Three major themes emerged: (1) Challenged by dementia-related impairments; (2) Valuing communication in care; and (3) Home is a personal space. Findings revealed that PSWs experience difficulties communicating with PLWD because of dementia-related impairments, despite PSWs recognizing the importance of communication when they provide optimal care in the homes of PLWD. This suggests that PSWs view communication as a crucial component of quality care but do not possess the skills necessary to ensure effective interactions. Findings also demonstrated the importance, uniqueness and impact of the personal home space on PSWs' experiences with communication. CONCLUSION Overall, findings indicate that PSWs acknowledge the importance of communication as an integral element of providing optimal care, but dementia-related impairments and the intimate, personal home-based care context can hinder successful communication between PSWs and PLWD. The implications of the findings are that additional and targeted education and training are required for PSWs, especially on how dementia-related impairments impact communication within the context of home care based services for PLWD.
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Affiliation(s)
- Pabiththa Kamalraj
- Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
| | | | - J B Orange
- School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
| | - Marita Kloseck
- School of Health Studies, Western University, London, Ontario, Canada
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20
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Lee JY, Lee KH, McConnell ES. Mealtime caregiving approaches and behavioral symptoms in persons living with dementia: a longitudinal, observational study. BMC Nurs 2021; 20:104. [PMID: 34154567 PMCID: PMC8215775 DOI: 10.1186/s12912-021-00621-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/27/2021] [Indexed: 11/30/2022] Open
Abstract
Background Behavioral symptoms during mealtime can prohibit persons living with dementia from obtaining sufficient nutrition. However, little research has examined the relationship between behavioral symptoms and caregiving approaches. This study examines this relationship and further explores which specific caregiver behaviors were related to behavioral symptoms among persons living with dementia. Methods A secondary data analysis was performed using 86 mealtime videos from a longitudinal, observational study. The videos were repeatedly taken at months 0, 3, and 6 with 30 persons living with dementia in one of four long-term care facilities. Video coding was performed using coding schemes modified from the Cohen-Mansfield Agitation Inventory for behavioral symptoms and the Person-/Task-Centered Behavior Inventory for caregiving approaches. Coding schemes for behavioral symptoms consisted of four categories: total duration, aggressive behavior, physically nonaggressive behavior, and verbally agitated behavior. Caregiving approaches consisted of ten-verbal/seven-nonverbal person-centered behavior codes, four-verbal/four-nonverbal task-centered behavior codes, and no-verbal/no-nonverbal interaction codes. A mixed-effect model was conducted using variables such as demographics, medical information, cognitive status, depression, function, and caregiving approaches as fixed effects, participant as a random effect, and four categories of behavioral symptoms as dependent variables. Results The total duration of the Cohen-Mansfield Agitation Inventory was associated with no verbal response (β = 9.09) and task-centered verbal behavior (β = 8.43), specifically verbal controlling (β = 7.87). Physically nonaggressive behavior was associated with no verbal response (β = 9.36). Verbally agitated behavior was associated with task-centered nonverbal behavior (β = 51.29), and specifically inappropriate touch (β = 59.05). Conclusions Mealtime is indispensable to dementia care for ensuring adequate nutrition and promoting personhood. Our findings revealed caregivers’ task-centered behaviors and no interaction were related to behavioral symptoms of persons living with dementia. When caregivers encounter behavioral symptoms during mealtime, it is recommended to avoid no response and task-centered behaviors, especially verbal controlling and inappropriate touch, and to promote person-centered behaviors.
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Affiliation(s)
- Ji Yeon Lee
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea
| | - Kyung Hee Lee
- Yonsei University College of Nursing and Mo-Im Kim Nursing Research Institute, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, South Korea.
| | - Eleanor S McConnell
- Geriatric Research, Education and Clinical Center (GRECC), Department of Veterans Affairs (VA) Medical Center, Duke University School of Nursing, Durham, NC, USA
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21
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Novy C, Thomas R, Garcia L, Gifford W, Grassau P. Using the performance arts to address a "methods gap" in dementia research. Arts Health 2021; 14:295-308. [PMID: 34152259 DOI: 10.1080/17533015.2021.1942093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Traditional methods of research have frequently failed to accommodate the communication difficulties experienced by a significant proportion of residents living in long-term care. In dementia research, specifically, there is cause for more collaborative, creative ways of working.Methods: The Linking Lives Through Care study is a performance-based narrative inquiry that will take place in a long-term care setting and will bring together all three members of the care triad - residents who are living with dementia, family members and personal support workers - to explore relational care from multiple positions and perspectives.Discussion: In this article, we discuss the design choices and creative measures taken to ensure a more inclusive research environment, specifically for those participants who are cognitively frail and/or may find it difficult to express their views using just words.
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Affiliation(s)
- Christine Novy
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Roanne Thomas
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Linda Garcia
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Wendy Gifford
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Pam Grassau
- School of Social Work, Carleton University, Ottawa, Canada
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De Sabbata K. Dementia, Treatment Decisions, and the UN Convention on the Rights of Persons With Disabilities. A New Framework for Old Problems. Front Psychiatry 2020; 11:571722. [PMID: 33240127 PMCID: PMC7680726 DOI: 10.3389/fpsyt.2020.571722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/22/2020] [Indexed: 11/20/2022] Open
Abstract
The UN Convention on the Rights of Persons with Disabilities has been at the center of considerable debate in the field of mental health. The discussion has caught up in particular after the publication of General Comment No. 1 in which the Committee on the Rights of Persons with Disabilities proposes a particularly radical interpretation of Article 12 of the Convention. Such a document has triggered skeptic and at times hostile reactions especially by psychiatrists, together with some positive comments. In this context, there is sometimes the tendency to focus only on the problematic aspects of the rights and support based model proposed by the CRPD and its Committee, forgetting that also "pre-CRPD" legislations on legal capacity present significant shortcomings. In this contribution I focus on the paradigmatic case of treatment decisions of people living with dementia with the aim to show how a number of provisions emerging from the CRPD and General Comment No. 1 can contribute to overcome the issues characterizing the traditional model of legal capacity and consent to treatment. First, I provide a brief overview of the provisions contained in the CRPD and General Comment No.1, summarizing the debate in this area. Then, I move to the case of treatment decisions of people living with dementia, analysing the main issues posed by the traditional model of capacity still characterizing European legislations. I will show how such problems and the solutions previously advanced by academics and practitioners resound in many ways with those identified by the CRPD and its Committee. In the second part, I analyse one by one the main provisions proposed by the CRPD and the Committee, studying how they can be applied in the area of treatment decisions of people living with dementia. In this context I point out the possible interpretations of the various provisions and their pros and cons, also referring to ongoing initiatives providing an insight on how such norms might work in practice.
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Affiliation(s)
- Kevin De Sabbata
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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23
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A communication model for nursing staff working in dementia care: Results of a scoping review. Int J Nurs Stud 2020; 113:103776. [PMID: 33120133 DOI: 10.1016/j.ijnurstu.2020.103776] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/04/2020] [Accepted: 09/13/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Communication between nursing staff and people with dementia can be challenging. According to the literature, communication is seen as a process of social- and/or informational exchange between a sender and a receiver in a context. Factors related to these elements determine the quality of communication. Insight into the factors involved in the communication process between nursing staff and people with dementia is limited and a comprehensive model of communication in dementia care is lacking. OBJECTIVES To identify and visualize factors associated with communication between nursing staff and people with dementia. DESIGN A scoping review of scientific literature. DATA SOURCES Scientific articles were retrieved from the bibliographic databases of PubMed, CINAHL and PsycINFO. REVIEW METHODS The reviewing process was directed by the Joanna Briggs guidelines for scoping reviews. Full-text articles describing the communication process between nursing staff and people with dementia were eligible for inclusion. A data extraction form was used to identify factors associated with communication. Following a directed content analysis approach, factors were categorized in one of three categories: nursing staff; people with dementia; or context. Each category was thematically analysed to identify themes and subthemes. Results were visualized into a communication model. RESULTS The review included 31 articles; in total, 115 factors were extracted. Thematic analysis of nursing staff factors (n = 78) showed that communication is associated with professional characteristics, individual experiences, verbal- and non-verbal communication skills, communication approach and values. Factors attributed to people with dementia (n = 22) concerned client characteristics, functional status, behaviour, verbal communication skills and values. Contextual factors (n = 15) related to organization of care, time and situation. Based on these results, the Contac-d model was constructed. CONCLUSIONS The Contac-d model gives a comprehensive overview of factors involved in the communication process between nursing staff and people with dementia, providing insight in potential starting points for communication improvement, e.g. respect for needs, identity and privacy of people with dementia, a flexible and adapted communication approach and matching language. Additionally, results suggest that an appealing location, longer duration of the interaction, and music in the surrounding may improve communication in certain situations. However, it was not feasible based on current literature to recommend what works to improve communication in which situations. Future studies should study factors and their interrelatedness in specific care situations. Authors further believe that more attention should be paid to strengths and capabilities of people with dementia and to non-modifiable factors that influence communication.
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24
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Vikström S, Grönstedt HK, Cederholm T, Franzén E, Seiger Å, Faxén-Irving G, Boström AM. A health concept with a social potential: an interview study with nursing home residents. BMC Geriatr 2020; 20:324. [PMID: 32887570 PMCID: PMC7487501 DOI: 10.1186/s12877-020-01731-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 08/23/2020] [Indexed: 12/26/2022] Open
Abstract
Background A qualitative, interview-based study was embedded in a randomized intervention trial, the Older People Exercise and Nutrition (OPEN) study. Participants in the OPEN study were encouraged to conduct sessions of sit-to-stand (STS) exercises combined with Oral Nutritional Supplements (ONS) intake. The aim was to describe the older persons’ perceptions and experiences of being given the daily opportunity to perform the STS exercise and drink ONS. Methods In-depth interviews were conducted in six nursing homes with the participants using a semi-structured interview guide. One or two individual interviews were performed with each included participant. Twenty-three NH residents (16 women and 7 men) participated in the qualitative study. Their ages ranged between 76 and 96 years, and their Mini Mental State Examination (MMSE) scored between 8 and 29. The transcribed interviews and field notes written during the visits were analyzed inductively following a constant comparative method described in Grounded Theory. Results The exercise and nutritional intervention was described as highly practical by the NH residents, who claimed it also had a social aspect as they felt acknowledged and empowered to engage others in the combined intervention. Experiences of the intervention ranged from neutral to mainly positive and could be sorted into 5 categories: 1. Perceived hopes and expectations, 2. Health-related driving forces, 3. Appreciated daily activities, 4. A concept easy to perform and integrate into daily life, 5. A beneficial health concept for all. The intervention created perceived benefits on various health aspects due to participants feeling energized and stronger. An overall theme was identified as A health concept with a social potential, as participants feel acknowledged and strong enough to help others. Conclusions The intervention was described by participants as a health concept that could potentially be beneficial for a broader spectrum of NH residents. The findings indicate that health concepts, such as STS/ONS, might contribute to a more meaningful day for older people, even vulnerable NH residents approaching the end of life. Trial registration ClinicalTrials.govIdentifier: NCT02702037. Date of trial registration February 26, 2016.
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Affiliation(s)
- Sofia Vikström
- Department of Neurobiology, Care Science and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden. .,Stockholms Sjukhem R&D unit, Stockholm, Sweden. .,Openlab, Stockholm, Sweden.
| | - Helena K Grönstedt
- Stockholms Sjukhem R&D unit, Stockholm, Sweden.,Allied Health Professionals, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Tommy Cederholm
- Department of Geriatric Medicine, Uppsala University Hospital, Uppsala, Sweden.,Karolinska University Hospital, Theme Aging, Stockholm, Sweden.,Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Erika Franzén
- Stockholms Sjukhem R&D unit, Stockholm, Sweden.,Allied Health Professionals, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.,Department of Neurobiology, Care Science and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Åke Seiger
- Department of Neurobiology, Care Science and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Gerd Faxén-Irving
- Stockholms Sjukhem R&D unit, Stockholm, Sweden.,Department of Neurobiology, Care Science and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Anne-Marie Boström
- Stockholms Sjukhem R&D unit, Stockholm, Sweden.,Karolinska University Hospital, Theme Aging, Stockholm, Sweden.,Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
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Blix BH, Berendonk C, Clandinin DJ, Caine V. The necessity and possibilities of playfulness in narrative care with older adults. Nurs Inq 2020; 28:e12373. [PMID: 32662183 DOI: 10.1111/nin.12373] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 11/27/2022]
Abstract
For us, narrative care is grounded in pragmatist philosophy and focused on experience. Narrative care is not merely about acknowledging or listening to people's experiences, but draws attention to practical consequences. We conceptualize care itself as an intrinsically narrative endeavour. In this article, we build on Lugones' understanding of playfulness, particularly to her call to remain attentive to a sense of uncertainty, and an openness to surprise. Playfulness cultivates a generative sense of curiosity that relies on a close attentiveness not only to the other, but to who we each are within relational spaces. Generative curiosity is only possible if we remain playful as we engage and think with experiences and if we remain responsive to the other. Through playfulness, we resist dominant narratives and hold open relational spaces that create opportunities of retelling and reliving our experiences. Drawing on our work alongside older adults, as well as people who work in long-term care, we show the possibilities of playfulness in the co-composition of stories across time. By intentionally integrating playfulness, narrative care can be seen as an intervention, as well as a human activity, across diverse social contexts, places and times.
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Affiliation(s)
- Bodil H Blix
- Department of Health and Care Sciences, Faculty of Health Sciences, Centre for Care Research North, UiT The Arctic University of Norway, Tromso, Norway
| | | | - D Jean Clandinin
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Vera Caine
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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Fauth EB, Meyer KV, Rose C. Co-occurrence of positive staff interactions and positive affect in memory-care residents: An observational study. Int J Geriatr Psychiatry 2020; 35:759-768. [PMID: 32240557 DOI: 10.1002/gps.5299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 01/02/2020] [Accepted: 02/13/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES With high numbers of persons with dementia living in residential care, it is vital to maximize psychosocial well-being for this population in this setting. The current study observed whether proportions of positive affect in residents differed based on co-occurring staff (typically certified nurse assistants) interaction types. METHODS A trained research team observed staff/resident interactions and affect in residents with dementia in common areas of a residential memory care unit (n = 22; observations over one year, or 6999 minutes total). RESULTS The most observed resident affect type was neutral (53.1% of all minutes observed), followed by positive affect (44.5%). The most common staff interaction type was neutral/no interaction (81.1% of all minutes observed), followed by positive staff interactions (18.1%). There was very little resident negative affect (2.4%) and staff negative interactions (.8%) observed. When staff had neutral/no/negative interactions, residents were positive 36% of the time, whereas when staff had positive interactions with them, residents were positive 81% of the time (z = 28.84, p < .001). A qualitative review of field notes identified themes and subthemes providing a more thorough understanding and context for the resident affect and staff interactions. While quantitative analyses suggested low rates of negative staff interaction, field notes highlight that neutral or no interactions with residents sometimes comprised missed opportunities, as well as more problematic lack of interaction (ignoring). CONCLUSIONS Not just avoiding negative interactions, but eliciting positive social interactions between staff and residents is important in promoting positive affect and overall wellbeing in persons with dementia.
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Affiliation(s)
- Elizabeth B Fauth
- Department of Human Development and Family Studies, Utah State University, Logan, Utah, USA
| | - Keirstin V Meyer
- Department of Human Development and Family Studies, Utah State University, Logan, Utah, USA
| | - Cassidy Rose
- Department of Human Development and Family Studies, Utah State University, Logan, Utah, USA
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Autonomy Support of Nursing Home Residents With Dementia in Staff-Resident Interactions: Observations of Care. J Am Med Dir Assoc 2020; 21:1600-1608.e2. [PMID: 32553488 DOI: 10.1016/j.jamda.2020.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/12/2020] [Accepted: 04/13/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES People with dementia living in nursing homes benefit from a social environment that fully supports their autonomy. Yet, it is unknown to what extent this is supported in daily practice. This study aimed to explore to which extent autonomy is supported within staff-resident interactions. DESIGN An exploratory, cross-sectional study. SETTING AND PARTICIPANTS In total, interactions between 57 nursing home residents with dementia and staff from 9 different psychogeriatric wards in the Netherlands were observed. METHODS Structured observations were carried out to assess the support of resident autonomy within staff-resident interactions. Observations were performed during morning care and consisted of 4 main categories: getting up, physical care, physical appearance, and breakfast. For each morning care activity, the observers consecutively scored who initiated the care activity, how staff facilitated autonomy, how residents responded to staff, and how staff reacted to residents' responses. Each resident was observed during 3 different mornings. In addition, qualitative field notes were taken to include environment and ambience. RESULTS In total, 1770 care interactions were observed. Results show that autonomy seemed to be supported by staff in 60% of the interactions. However, missed opportunities to engage residents in choice were frequently observed. These mainly seem to occur during interactions in which staff members took over tasks and seemed insensitive to residents' needs and wishes. Differences between staff approach, working procedures, and physical environment were observed across nursing home locations. CONCLUSIONS AND IMPLICATIONS The findings of this study indicate that staff members support resident autonomy in more than one-half of the cases during care interactions. Nonetheless, improvements are needed to support resident autonomy. Staff should be encouraged to share and increase knowledge in dementia care to better address residents' individual needs. Especially for residents with severe dementia, it seems important that staff develop skills to support their autonomy.
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Mondaca M, Johansson K, Josephsson S, Rosenberg L. In search for the "humane": staffs' perspectives on everyday activities in a nursing home. Aging Ment Health 2020; 24:679-688. [PMID: 30739478 DOI: 10.1080/13607863.2019.1574709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objectives: To better understand how a dialogue about the influence of nursing home residents on their everyday activities evolve among diverse practitioners and to identify the consequences of such an understanding in practice.Methods: Inspired by a collaborative approach, five workshops, one focus group and follow up interviews were conducted. The participants were 19 diverse practitioners. Analysis followed a dialogical approach.Findings: Tensions, opportunities and challenges were articulated and discussed during the workshops and are developed in: a) Bypassing the "humane"? The dilemma between using shields preventing engagement or acting in a clandestine manner b)"What is our stance?" Seeking common ground on which to stand regarding everyday activities and c) Recognising expertise and seeking connections.Discussion: For the staff, acting in a clandestine manner seems to create ways of enabling "humane" practices towards nursing home residents. The "clandestine manners" seem to be grounded in an effort on the part of the staff to make sense of the everyday activities for the nursing home residents. These "clandestine manners" could be seen as responses to institutional routines and a lack of common ground on the understanding of everyday activities in the context of nursing homes.
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Affiliation(s)
- Margarita Mondaca
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
| | - Karin Johansson
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
| | - Staffan Josephsson
- Department of Applied Social Sciences, NTNU, Norway University of Technology and Science, Trondheim, Norway
| | - Lena Rosenberg
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
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Wood S. Beyond Messiaen's birds: the post-verbal world of dementia. MEDICAL HUMANITIES 2020; 46:73-83. [PMID: 31142577 PMCID: PMC7042969 DOI: 10.1136/medhum-2018-011616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/15/2019] [Accepted: 01/30/2019] [Indexed: 06/09/2023]
Abstract
This paper investigates the use of verbatim musical transcription as a research method in dementia care. It reports on an art-based ethnographic study (Aesthetic Research in Everyday Life (Aeriel)) in which verbatim transcription was applied to everyday interactions in dementia care, making use of musical-instead of verbal-notation. Starting from the notion that medical and healthcare settings can be sites of 'found performance', the paper reviews literature relating to artistic methodologies within medical humanities, music, ethnography and dementia care. From this review, it proposes a research design and method of verbatim musical transcription as a potential avenue of investigating communication between carer and cared for in dementia care. The paper offers an illustrative example from Aeriel and draws conclusions from the synthesis of verbal and musical data analysis. Findings indicate an important advance in studies of dementia care communication towards a concept of the 'post-verbal' enabled by a musical research method and the clinical applications that it offers.
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Affiliation(s)
- Stuart Wood
- Guildhall School of Music and Drama, London, UK
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Yamazaki R, Kase H, Nishio S, Ishiguro H. Anxiety Reduction Through Close Communication with Robotic Media in Dementia Patients and Healthy Older Adults. JOURNAL OF ROBOTICS AND MECHATRONICS 2020. [DOI: 10.20965/jrm.2020.p0032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The purpose of this paper is to provide an overview of the recent research on android robotic media with a focus on its effects on older adults and to present a discussion on the implications of the experimental results. Social isolation of older adults is a leading issue in healthcare. Patients with dementia experience symptoms, such as agitation, which can result in increasing care burden. Android robotic media have been shown to provide a feeling of safety and communication support to older adults. In previous case studies, an increase in prosocial behaviors was observed in participants with dementia; however, the media effects needed to be measured by assessment scales. The current results indicate the effects of robotic media on dementia symptoms, especially the decrease in patients’ anxiety. As demonstrated in another experiment, anxiety reduction can also be expected in healthy older adults; however, certain conditions may be required for both healthy older adults and those with dementia. Key factors for the media effect, namely, dementia type, user’s personality, and personalized dialogue are taken into consideration for the further development of robotic systems. Additionally, we further discuss the significance of long-term data collection, especially from the early life stages because teleoperation or autonomous systems are expected to utilize information that can affect the effect of robotic media.
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Fossey J, Garrod L, Lawrence V, Testad I, Stafford J, Murray J. "We should see her like part of the team": an investigation into care home staff's experiences of being part of an RCT of a complex psychosocial intervention. Aging Ment Health 2020; 24:178-185. [PMID: 30569749 DOI: 10.1080/13607863.2018.1525603] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: To contribute to improvements in the design and delivery of intervention research in care homes by adopting a collaborative approach that listens to the experiences of care home staff who had participated in a clinical trial aimed at optimising and evaluating a psychosocial intervention package for people with dementia.Methods: Qualitative study involving focus group discussions (FGDs) involving 41 staff across 6 care homes with the UK. Inductive thematic analysis was used to identify themes and interpret the data.Results: Three overarching themes emerged as influential: Recognising preparedness; working together and learning more than expected. The findings highlighted the need to be attentive in addressing staff expectations, the value of sustained relationships and recognition of good practice. The FGDs also identified areas of unanticipated learning that staff and managers adopted.Conclusions: The FGDs showed the importance of considering the overall experience of care home staff who are involved in research and the importance of valuing the skills and experience they hold through positive affirmation. There are often unanticipated consequences of research involvement both on staff practice and on relationships which if promoted could help sustain effective ways of working together.
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Affiliation(s)
- Jane Fossey
- Oxford Health NHS Foundation Trust, Fulbrook Centre, Churchill Hospital, Oxford, UK
| | - Lucy Garrod
- Oxford Health NHS Foundation Trust, Fulbrook Centre, Churchill Hospital, Oxford, UK
| | - Vanessa Lawrence
- Health Services & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ingelin Testad
- Centre for Age-Related Medicine, SESAM, Stavanger University Hospital, Stavanger, Norway
| | - Jane Stafford
- Health Services & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Joanna Murray
- Health Services & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Cleeve H, Borell L, Rosenberg L. (In)visible materialities in the context of dementia care. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:126-142. [PMID: 31562648 PMCID: PMC7004116 DOI: 10.1111/1467-9566.12988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Seemingly mundane materialities are intertwined with important, but often neglected, care interactions. It has been argued that if healthcare professionals paid more attention to the roles materialities can have, everyday routines could become important occasions for care. In response to such proposals, we argue that it is relevant to examine how materialities are currently understood. In this article, we explore materialities as part of work in a dementia unit. Using abstracted illustrations of everyday materialities to elicit reflections, we conducted 11 individual interviews with certified nursing assistants. Through phenomenographic analysis we explain our findings as three different categories conceptualising understandings of materialities as: 'tools for care', 'a set of principles for care' and 'caring relationships'. Our analysis indicates that understanding materialities as instruments was reinforced and made visible through the healthcare organisation while understanding materialities as part of specific relationships with residents appeared informal and less visible. How materialities were understood seemed to have several implications for residents. While care practices could benefit from nursing assistants' abilities to alternate between ways of understanding materialitites, such competence seemed dependent on how professional care was organised, structured and materialised.
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Affiliation(s)
- Helena Cleeve
- Department of Neurobiology, Care Sciences and SocietyDivision of Occupational TherapyKarolinska InstitutetHuddingeSweden
| | - Lena Borell
- Department of Neurobiology, Care Sciences and SocietyDivision of Occupational TherapyKarolinska InstitutetHuddingeSweden
| | - Lena Rosenberg
- Department of Neurobiology, Care Sciences and SocietyDivision of Occupational TherapyKarolinska InstitutetHuddingeSweden
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Berendonk C, Blix BH, Hoben M, Clandinin DJ, Roach PM, Compton RM, Cave MT, Caine V. A Narrative Care approach for persons living with dementia in institutional care settings. Int J Older People Nurs 2019; 15:e12278. [PMID: 31577388 DOI: 10.1111/opn.12278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/26/2019] [Accepted: 08/29/2019] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES We will provide insights in the theoretical background and key concepts of a Narrative Care approach, such as narrative cultures, narrative curiosity, narrative co-composition and narrative reflective practice. BACKGROUND Care understood as narrative practice underscores the importance of experiences and how these shape identities. Important to the quality of care in institutional care settings is the ability of care providers to cope with complexities and uncertainties in older adults' stories, which can be realised by attending to ways that foster and co-compose evolving and forward-looking narratives. Recognising these ongoing co-compositions means that persons living in institutional care settings and care providers live, tell, retell and relive their experiences. A change in the current institutional culture is necessary to implement care as narrative practice. To support such a change, approaches are needed that foster a focus on experiences and relationships and make relational ethics central to care. METHODS The proposed Narrative Care approach is the result of an iterative development process involving a literature review, interviews with, and observations of, care providers, dialogues with an advisory committee, and consultation with experts. MAIN CONTRIBUTIONS The proposed Narrative Care approach aims to help care providers (a) to recognise the importance of curiosity in a person's verbal and embodied narratives-especially for those living with dementia; (b) to take note of individual experiences in all of their complexity and uncertainty; (c) to respect these narratives; (d) to open up spaces to co-compose new narratives; and (e) to allow care providers to engage in narrative reflective practices that shape who they are and are becoming. CONCLUSION The introduced approach responds to the need of implementing strategies to think and work narratively in institutional care settings. IMPLICATIONS FOR PRACTICE Narrative Care has the potential to reshape task-oriented, technical notions of care. Concepts such as embodied narratives, relational ethics, narrative co-composition and narrative reflective practice must be integrated in the education of all care providers.
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Affiliation(s)
| | - Bodil H Blix
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - D Jean Clandinin
- Faculty of Education, University of Alberta, Edmonton, AB, Canada.,Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Pamela M Roach
- Brain and Mental Health Research Clinics, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Roslyn M Compton
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
| | - Marie T Cave
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Vera Caine
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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Chatwin J, Capstick A. The influence of subliminal crosstalk in dementia narratives. DEMENTIA 2019; 18:1740-1750. [DOI: 10.1177/1471301217724922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ethnographic audio-visual research data recorded in a busy dementia care environment were initially considered to be ‘contaminated’ by unwanted background noise. This included a variety of elements: ambient sound, mechanical noise, non-narrative vocalisation and narrative fragments from parallel conversation. Using the methodological lens of conversation analysis, we present an exploration of the striking temporal and sequential resonances between the narrative of one man with dementia and a group of care staff holding a separate conversation some distance away. We suggest that in this and similar settings, where random and intrusive background sounds and conversation form a ubiquitous backdrop, the presence of such ‘noise’ can have a detectable influence on the content and direction of situated narratives. We argue that rather than attempting to filter out these apparently intrusive sounds from micro-interactional data, interference elements can usefully be incorporated into the analysis of interactions.
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Windle G, Algar-Skaife K, Caulfield M, Pickering-Jones L, Killick J, Zeilig H, Tischler V. Enhancing communication between dementia care staff and their residents: an arts-inspired intervention. Aging Ment Health 2019; 24:1306-1315. [PMID: 30884963 PMCID: PMC7446032 DOI: 10.1080/13607863.2019.1590310] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives: The arts are increasingly recognised as important and beneficial activities for people living with dementia. However, there is little peer-reviewed published research exploring arts-based learning for dementia care staff. In response, this paper explores (a) how dementia care staff describe forms of communication in care settings, and (b) the impact on communication following four sessions of 'Creative Conversations', an arts-based intervention for skills development.Method: Fourteen care homes received the intervention, delivered as 4 × 2 hour sessions. The intervention uses a range of activities (e.g. poetry, film, music, art making). Twenty-eight care staff were opportunistically sampled (mean age = 42.29), and provided pre-post qualitative data, obtained through interviews. Transcripts were analysed thematically.Results: At baseline, the dominant 'task-focussed' nature of care work was described as a barrier to communication, challenging opportunities for developing meaningful relationships with residents. Post-intervention, three primary themes were identified regarding improving communication: (1) learning through the arts (secondary themes: simplicity and subtlety, innovation in communication, and strengthening the role of non-verbal communication), (2) Enhancing creative approaches to care (secondary themes: element of surprise, confidence to experiment and catalyst for communication) and (3) professional introspection (secondary themes: development of empathy, sharing knowledge and experiences and a new appreciation).Conclusions: The intervention validated staff skills and confidence, enabling meaningful interactions that could be creative, 'in the moment', spontaneous and improvised. This arts-based intervention, which departs from formal education and fact-based learning may be particularly useful for the development of the dementia care workforce.
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Affiliation(s)
- Gill Windle
- Ageing and Dementia@Bangor/DSDCWales, School of Health Sciences, Bangor University, Bangor, Wales; ,CONTACT Gill Windle @victischler https://www.linkedin.com/in/victoriatischler/
| | - Katherine Algar-Skaife
- Ageing and Dementia@Bangor/DSDCWales, School of Health Sciences, Bangor University, Bangor, Wales;
| | - Maria Caulfield
- Ageing and Dementia@Bangor/DSDCWales, School of Health Sciences, Bangor University, Bangor, Wales;
| | | | - John Killick
- Dementia Positive, Yorkshire, United Kingdom of Great Britain and Northern Ireland;
| | - Hannah Zeilig
- University of the Arts London and University of East Anglia, London, England;
| | - Victoria Tischler
- College of Nursing, Midwifery and Healthcare, University of West London, London, England
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Villar F, Serrat R, Bravo-Segal S. Giving Them a Voice: Challenges to Narrative Agency in People with Dementia. Geriatrics (Basel) 2019; 4:geriatrics4010020. [PMID: 31023988 PMCID: PMC6473304 DOI: 10.3390/geriatrics4010020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/08/2019] [Accepted: 02/10/2019] [Indexed: 11/23/2022] Open
Abstract
In this paper, we argue that the capacity for narrative agency is significantly compromised in individuals with dementia due to at least three factors: (a) Dementia itself, which causes increasing difficulties in constructing and articulating coherent and meaningful stories, and sharing them with others; (b) cultural narratives about dementia, which promote an extremely negative and pessimistic view of those with the disease; and (c) the convergence of these two last factors, which can lead to caregiving interactions that do not support storytelling and can even stop people with dementia from telling stories. We highlight the importance of narrative care, which involves interventions that focus on the person and their unique life narrative. In narrative care, people with dementia are treated not as impaired patients defined by the disease, but as human beings. In doing so, people with dementia can have their own voices back, which is silenced and discredited so many times.
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Affiliation(s)
- Feliciano Villar
- Cognition, Development, and Educational Psychology Department, University of Barcelona, 08035 Barcelona, Spain.
| | - Rodrigo Serrat
- Cognition, Development, and Educational Psychology Department, University of Barcelona, 08035 Barcelona, Spain.
| | - Stephany Bravo-Segal
- Cognition, Development, and Educational Psychology Department, University of Barcelona, 08035 Barcelona, Spain.
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Lindholm C, Wide C. Self-directed speech and dialogue in dementia care: the potential of co-participants' contributions. LOGOP PHONIATR VOCO 2019; 44:14-22. [PMID: 30693814 DOI: 10.1080/14015439.2019.1554853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Dementia is associated with an ongoing decline in language function, involving both language production and comprehension. Maintaining a conversation with persons with dementia may be challenging. In this study, we investigate how the contributions of professional caregivers affect the linguistic contributions of the speaker with dementia. METHODS This is a conversation analytic case study of one individual with dementia. The data are drawn from a five-hour video corpus collected at a Swedish speaking care facility in Finland. RESULTS In comparing self-directed speech and dialogue, the results show how professional caregivers can induce change in the linguistic and interactional behaviors of a person with dementia. CONCLUSIONS Introducing an interactional perspective to self-directed speech and dialogue, this study provides new insights into the notion of a "good conversation" in dementia care.
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Affiliation(s)
- Camilla Lindholm
- a Department of Finnish Language, Finno-Ugrian and Scandinavian Studies , University of Helsinki , Helsinki , Finland
| | - Camilla Wide
- b Scandinavian Languages , University of Turku , Turku , Finland
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Nguyen H, Terry D, Phan H, Vickers J, McInerney F. Communication training and its effects on carer and care-receiver outcomes in dementia settings: A systematic review. J Clin Nurs 2018; 28:1050-1069. [DOI: 10.1111/jocn.14697] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 09/16/2018] [Accepted: 10/18/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Hoang Nguyen
- Wicking Dementia Research and Education Centre; College of Health and Medicine; University of Tasmania; Hobart Tasmania Australia
| | - Daniel Terry
- Faculty of Health; Federation University; Ballarat Victoria Australia
| | - Hoang Phan
- Menzies Institute for Medical Research; College of Health and Medicine; University of Tasmania; Hobart Tasmania Australia
| | - James Vickers
- Wicking Dementia Research and Education Centre; College of Health and Medicine; University of Tasmania; Hobart Tasmania Australia
| | - Fran McInerney
- Wicking Dementia Research and Education Centre; College of Health and Medicine; University of Tasmania; Hobart Tasmania Australia
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Garabedian CE, Kelly F. Haven: Sharing receptive music listening to foster connections and wellbeing for people with dementia who are nearing the end of life, and those who care for them. DEMENTIA 2018; 19:1657-1671. [PMID: 30309252 DOI: 10.1177/1471301218804728] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper reports on research exploring the effects of music played for 12 dyads: a care home resident ('resident') with dementia and someone closely connected to him/her ('carer'). Six individualised music interventions (3 live and 3 pre-recorded) were played by the first author on solo cello within five Scottish non-NHS care homes. All interventions were video-recorded. Semi-structured interviews with carer participants, key staff, and managers explored their responses to interventions. Thick descriptions of video recordings and interview transcripts were thematically coded using Nvivo. A key finding was that structural elements of the interventions combined with characteristics of the music played facilitated an internalised experience of 'haven'; sonically transporting listeners away from their present reality and fulfilling the basic human needs for inclusion, comfort, identity, occupation and attachment.
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Affiliation(s)
| | - Fiona Kelly
- Centre for person-centred practice research, Queen Margaret University, UK
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Cameron N, Fetherstonhaugh D, Bauer M, Tarzia L. How do care staff in residential aged care facilities conceptualise their non-verbal interactions with residents with dementia and what relevance has this for how residents' preferences and capacity for decision-making are understood? DEMENTIA 2018; 19:1364-1380. [PMID: 30189746 DOI: 10.1177/1471301218798422] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This paper considers the significance of how staff in residential aged care facilities interpret the non-verbal communication and behaviour of residents vis-a-vis their assessments of residents' preferences and ability to participate in decision-making. It highlights the risks associated with staff members' failure to interpret residents' non-verbal communication and behaviour with reference to residents' backgrounds and prior experiences. It also considers how non-verbal communication implemented by staff may impact residents' emotional state and, as a consequence, decision-making abilities. Drawing on interview data with aged care staff from Queensland and Victoria, it demonstrates that care staff in residential facilities appear to rely heavily on non-verbal signals in assessing the decision-making capacity and preferences of residents with dementia. It also indicates that many staff fail to consider residents' non-verbal communication and behaviour with due consideration of residents' individual histories.
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Affiliation(s)
| | | | - Michael Bauer
- Australian Centre for Evidence Based Aged Care, La Trobe University, Australia
| | - Laura Tarzia
- Department of General Practice, The University of Melbourne, Australia
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Novy C. Themes of care giving and receiving in the interconnecting stories of a mother living with dementia and her adult son: A single-case life story study. J Aging Stud 2018; 46:32-36. [DOI: 10.1016/j.jaging.2018.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 06/09/2018] [Indexed: 11/30/2022]
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Abstract
OBJECTIVE This qualitative study seeks evidence of retained social awareness in individuals with moderate dementia residing in care-homes, when engaged in interactive family visits. METHOD Speech/non-speech data collected from 10/15-minute video-recorded family interactions of five family groups (12 individuals; 2 sessions per family group) were coded using thematic analysis. RESULTS Interactional patterns embedded in familiar bonds provided the context for the superordinate theme: relational social engagement (RSE). This overarched two subthemes: in-step and out-of-step; highlighting that RSE, can occur as a result of both positive and negative familial communication patterns. When familial communication was in-step, despite changed communication pathways, the resident's attempts at social engagement appeared open, relaxed, and responsive. A sense of trust, and familiarity appeared to facilitate reciprocal understanding and the striving of resident family members to retain family group membership. When familial communication was out-of-step, active attempts at reciprocity or open engagement from visiting family members were not observed. At such times, communication became discordant, and frustrated in their efforts to remain an integral part of the family group, the resident appeared disinterested or guarded often retorting with annoyance at visiting family members. CONCLUSION The construct of RSE appears specific to prior meaningful relationships, where optimal social awareness and communication, positive and negative, can occur. Currently, dementia assessment and care does not include RSE during family interactions. Implications are discussed.
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Affiliation(s)
- Bruce Walmsley
- a School of Psychology , University of Newcastle , Callaghan , NSW 2308 , Australia
| | - Lynne McCormack
- b HammondCare , Centre for Positive Ageing , Hammondville , NSW 2170 , Australia
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Sandberg LJ. Dementia and the gender trouble?: Theorising dementia, gendered subjectivity and embodiment. J Aging Stud 2018; 45:25-31. [DOI: 10.1016/j.jaging.2018.01.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Cleeve H, Tishelman C, Macdonald A, Lindqvist O, Goliath I. Not just things: the roles of objects at the end of life. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:735-749. [PMID: 29480548 DOI: 10.1111/1467-9566.12719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
While the study of objects in care contexts is an emerging research field, it is largely overlooked in end of life (EoL) care. In this study, we empirically and inductively explore the roles of objects at the EoL from the perspective of bereaved family members. Open individual interviews were conducted with 25 family members recruited from palliative in-patient and homecare units, as well as residential care facilities. After verbatim transcription, the interviews were analysed thematically. Based on these interviews, we conceptualise the roles of objects as relating to temporality, transformations of the everyday, and care. Through analysis we offer two main insights, the first relating to interdependency between objects and people, and the second to the recognition of objects as simultaneously flexible and stable in this interdependent relationship. The capacity and challenge of objects as part of EoL care lies in their ability to encompass various viewpoints and relationships simultaneously. This might provide valuable insights for staff caring for dying persons and their families. We propose that staff's ability to navigate objects in care practices could be meaningful in supporting the relationships between individuals in EoL situations.
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Affiliation(s)
- Helena Cleeve
- Karolinska Institutet, NVS, Division of Occupational Therapy, Sweden
| | - Carol Tishelman
- Karolinska Institutet, LIME, MMC, Innovative Care research group, Stockholm, Sweden
- Karolinska University Hospital, Innovation Centre, Stockholm, Sweden
| | | | - Olav Lindqvist
- Karolinska Institutet, LIME, MMC, Innovative Care research group, Stockholm, Sweden
- Department of Nursing, Umeå University, Sweden
| | - Ida Goliath
- Karolinska Institutet, LIME, MMC, Innovative Care research group, Stockholm, Sweden
- Ersta Sköndal University College and Hospice Ersta Hospital, Palliative Research Centre, Stockholm, Sweden
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Buse C, Twigg J. Dressing disrupted: negotiating care through the materiality of dress in the context of dementia. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:340-352. [PMID: 29464768 PMCID: PMC6849805 DOI: 10.1111/1467-9566.12575] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This paper explores how the materiality of dress mediates and shapes practices of care in the context of dementia. Earlier research called for an approach to conceptualising care that recognised the role played by everyday artefacts. We extend this to a consideration of dress and dressing the body in relation to people with dementia that involves the direct manipulation of material objects, as well as the materiality of bodies. The paper draws on an ESRC funded study Dementia and Dress, which examined experiences of dress for people with dementia, families and care-workers using ethnographic and qualitative methods. Our analysis explores the process of dressing the body, the physicality of guiding and manipulating bodies into clothing, dealing with fabrics and bodies which 'act back' and are resistant to the process of dressing. We consider how the materiality of clothing can constrain or enable practices of care, exploring tensions between garments that support ease of dressing and those that sustain identity. Examining negotiations around dress also reveals tensions between competing 'logics' of care (Mol ).
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Affiliation(s)
| | - Julia Twigg
- Social Policy, Sociology and Social ResearchUniversity of KentCanterburyUK
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Abstract
BACKGROUND There are some existing barriers posed by neuropsychological tests that interfere with the assessment of cognitive functioning by staff who work in long-term care facilities. The purpose of this study was to investigate the feasibility of assessing cognitive function through conversation. METHODS A total of 100 care staff was randomly selected as participants. Each staff member evaluated cognitive function in one to three residents using the Conversational Assessment of Neurocognitive Dysfunction (CANDy), which is a screening test for dementia using conversation. Other scales used were the Mini-Mental State Examination (MMSE), Behavioral Pathology in Alzheimer' s Disease (BEHAVE-AD), and quality-of-life questionnaire for the elderly with dementia (QOL-D). RESULTS A total of 80 care staff members and 158 residents were analyzed. When the CANDy involved an evaluation based on face-to-face communication, it demonstrated significant correlations with the MMSE, BEHAVE-AD, and several indices of the QOL-D (e.g. negative affect and actions, communication ability, restless, and spontaneity and activity). In contrast, when the CANDy involved an evaluation based on an impression of a typical conversation, it only demonstrated significant relationships with the MMSE and the spontaneity and activity index of the QOL-D. CONCLUSIONS Conversational assessment is a useful means to assess cognitive functioning and to promote interactions between residents and care staff in long-term care facilities.
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Beerens HC, Zwakhalen SMG, Verbeek H, E S Tan F, Jolani S, Downs M, de Boer B, Ruwaard D, Hamers JPH. The relation between mood, activity, and interaction in long-term dementia care. Aging Ment Health 2018; 22:26-32. [PMID: 27624397 DOI: 10.1080/13607863.2016.1227766] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of the study is to identify the degree of association between mood, activity engagement, activity location, and social interaction during everyday life of people with dementia (PwD) living in long-term care facilities. METHOD An observational study using momentary assessments was conducted. For all 115 participants, 84 momentary assessments of mood, engagement in activity, location during activity, and social interaction were carried out by a researcher using the tablet-based Maastricht Electronic Daily Life Observation-tool. RESULTS A total of 9660 momentary assessments were completed. The mean age of the 115 participants was 84 and most (75%) were women. A negative, neutral, or positive mood was recorded during 2%, 25%, and 73% of the observations, respectively. Positive mood was associated with engagement in activities, doing activities outside, and social interaction. The type of activity was less important for mood than the fact that PwD were engaged in an activity. Low mood was evident when PwD attempted to have social interaction but received no response. CONCLUSION Fulfilling PwD's need for occupation and social interaction is consistent with a person-centred dementia care focus and should have priority in dementia care.
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Affiliation(s)
- Hanneke C Beerens
- a Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences , Maastricht University , Maastricht , The Netherlands
| | - Sandra M G Zwakhalen
- a Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences , Maastricht University , Maastricht , The Netherlands
| | - Hilde Verbeek
- a Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences , Maastricht University , Maastricht , The Netherlands
| | - Frans E S Tan
- b Department of Methodology & Statistics, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences , Maastricht University, Maastricht , The Netherlands
| | - Shahab Jolani
- b Department of Methodology & Statistics, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences , Maastricht University, Maastricht , The Netherlands
| | - Murna Downs
- c School of Dementia Studies, Faculty of Health Studies , University of Bradford , Bradford , United Kingdom
| | - Bram de Boer
- a Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences , Maastricht University , Maastricht , The Netherlands
| | - Dirk Ruwaard
- a Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences , Maastricht University , Maastricht , The Netherlands
| | - Jan P H Hamers
- a Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences , Maastricht University , Maastricht , The Netherlands
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Abstract
BACKGROUND Many strategies have been recommended to support caregivers in communicating with people who live with dementia. However, less is known about what makes communication a good and meaningful experience from the perspective of people with dementia. Understanding this may enhance the person with dementia's sense of connectedness, strengthen their relationships, and facilitate person-centered care. The current review aimed to evaluate research that examined experiences of communication in people living with dementia. Studies that examined reports provided by people with dementia, healthcare professionals, and family caregivers were included. METHODS A mixed-methods systematic review was conducted using PsychINFO, MEDLINE, and EMBASE databases. RESULTS After applying the eligibility criteria, 15 studies were included. Although eight of these recruited people with dementia, only one focused on their perspectives of communication experiences and the remaining studies focused on the perspectives of family caregivers and healthcare professionals. These studies either explored experiences without suggestions of communication methods, "open exploration," or through examining experiences of strategies, "exploration of strategies." A significant theme was around communication difficulties that affected interpersonal relationships and activities of daily living. Conversely, personhood strategies and a strong underlying relationship were believed to facilitate communication. The one study that examined the perspectives of people with dementia emphasized the importance of retaining valued relationships and feeling respected during communication. CONCLUSIONS The need to involve people with dementia in research, particularly around their experiences of communication, is evident. Such research would be imperative for facilitating person-centered care, strengthening social relationships, and informing training programs.
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Berendonk C, Kaspar R, Bär M, Hoben M. Improving Quality of Work life for Care Providers by Fostering the Emotional well-being of Persons with Dementia: A Cluster-randomized Trial of a Nursing Intervention in German long-term Care Settings. DEMENTIA 2017; 18:1286-1309. [DOI: 10.1177/1471301217698837] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We tested the feasibility of a nursing intervention (DEMIAN) in routine care and its effects on care providers’ job satisfaction, motivation, and work strain. This cluster-randomized trial was conducted in 20 German long-term care facilities. We randomly assigned 20 facilities to an intervention group (84 care providers, 42 residents with dementia) or a control group (96 care providers, 42 residents with dementia). Intervention group providers received two training days on the intervention; 68 providers attended both training days. Sixty two providers completed both baseline and follow-up questionnaires. Trained providers created individualized mini-intervention plans for participating residents. Control group residents received ‘usual care’. Intervention group providers stated that the intervention was feasible and helped them improve emotional well-being of residents with dementia. We found significantly decreased time pressure and decreased job dissatisfaction for intervention group providers. DEMIAN is an effective and pragmatic contribution to implementing person-centred care in long-term care, with positive effects on providers’ working conditions.
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Affiliation(s)
- Charlotte Berendonk
- Institute of Gerontology, University of Heidelberg, Germany; Faculty of Nursing, University of Alberta, Canada
| | - Roman Kaspar
- Institute of Gerontology, University of Heidelberg, Germany; Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health, University of Cologne, Germany
| | - Marion Bär
- Institute of Gerontology, University of Heidelberg, Germany; concept.alter, Heidelberg, Germany
| | - Matthias Hoben
- Institute of Gerontology, University of Heidelberg, Germany; Faculty of Nursing, University of Alberta, Canada
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